Lincy George

Falls are the major cause of morbidity and mortality among the elderly. Falls are caused by a combination of factors. Most of these falls are caused by intricate interactions between environmental and internal causes. The use of benzodiazepines is linked to a high proportion of falls among older people. Benzodiazepines are a class of drugs that can treat a range of conditions. Doctors often prescribe them to treat anxiety, seizures, and insomnia. The short-term use of these medications is usually safe and effective, but long-term use can lead to tolerance, dependence, and other adverse effects. After falls, older people frequently experience a loss in functional status and social activities, as well as a lower quality of life. Therefore, they should be provided to elderly patients under the current clinical standards and reviewed on a regular basis. The therapy of choice should be short-acting benzodiazepines in the elderly population. It should be given as a short-term treatment and gradually tapered thereafter. Benzodiazepines should be replaced with safer alternatives such as sleep restriction therapy, cognitive behavioural therapy, and sleep hygiene psychoeducation. In this article, we examine the evidence on the prevalence of benzodiazepine usage and drug dependence, as well as the fall risk of benzodiazepines in the elderly.

Hepatorenal syndrome (HRS) is a potentially reversible renal impairment where the kidney function is stopped due to renal vasoconstriction resulting from extreme vasodilation. This case report describes a 64 year old female with Decompensated Chronic Liver Disease. Her clinical history and physical findings shows a decreased renal function secondary to chronic liver disease and was later diagnosed as HRS. HRS can be managed effectively with Terlipressin, Midodrine, Albumin. Such combination therapy at the early stage of diagnosis can prevent further complications.

Anticoagulant therapy being the most conventional form of therapeutic intervention is the cornerstone for the treatment and prevention of various ailments including Atrial Fibrillation (AF), Acute Coronary Syndrome (ACS), Venous Thromboembolism (VTE) and patients undertaking cardiac procedures1. Bleeding is the principal complication of anticoagulants even though used within its therapeutic limit. An innovative tool HAS-BLED score come up with the assessment of bleeding risk among patients under anticoagulant therapy supporting the physicians in a better clinical decision making2,3. The objective is to evaluate drug use and bleeding risk of anticoagulant drugs using HAS-BLED Score among geriatric patients. A prospective observational study was conducted in a tertiary care hospital among hundred patients for a period of six months. It was found that 61% were males and 49% were females. Most of the patients were from the age group of 65-70 (53%), 71-75 (31%) and least less than 75 (16%). The most commonly prescribed dosage form was parenteral (79%) and drug was heparin (52%). The bleeding risk of twenty patients taking warfarin was assessed using HAS- BLED Score, the risk categories shows greater than or equal to 3 (60%) high risk and score between 1-2 (40%) moderate risk. Drug use pattern of anticoagulants needs uninterrupted and repeated surveillance not only to discern therapeutic efficacy but also to scrutinize potential adverse drug reaction. From the HAS-BLED score distribution of patients taking warfarin conveys the need to monitor the parameters especially INR before and after initiation of anticoagulant therapy.

Corticosteroids are the drugs used for multifarious diseases because of their widespread action. It is suggested that these drug use should not be ceased rapidly, rather than it should be finished gently. Due to their diversity of actions and uses, more no of interactions with the drugs and diseases were recorded. It is well known that there is a strong relationship between corticosteroid use and psychiatric effects. Both the steroid induced psychiatric symptoms and diagnosis are uncertain. Hence Pharmacists are the best person to mould a suitable drug therapy and a management regimen for corticosteroids induced adverse events in patients. They can also play an important role in educating the patients about corticosteroids and their psychic disturbances. Since physicians do not take any interest in to alert the patients about the usage, interactions and highly severe psychiatric problems of steroids, the need of pharmacists becomes very important.